Cost-Effectiveness of Non-Pharmacological Interventions for Mild Cognitive Impairment and Dementia: A Systematic Review of Economic Evaluations and a Review of Reviews
PharmacoEconomics
Eaglestone, G., Gkaintatzi, E., et al. (2023).
PharmacoEconomics, 7(6), 887-914.
This systematic review investigates the cost-effectiveness of interventions for individuals with mild cognitive impairment and dementia. Only those interventions within the scope of practice of a speech-language pathologist are included in this article summary.
University of Greenwich (United Kingdom)
From January 1, 2011 to May 11, 2023
All study designs including reviews and systematic reviews
41 (14 within SLP scope of practice)
<div>Cognitive stimulation therapy (CST) resulted in mixed findings for adults with dementia or MCI across three studies: </div>
<ul>
<li><span style="color: #333333;">Standard CST did not improve quality of life or cognition in one study. </span></li>
<li><span style="color: #333333;">Maintenance CST (i.e., a group-based CST program designed to maintain cognitive function over time) was found to be cost-effective within one study. </span></li>
<li><span style="color: #333333;">Maintenance CST was found to be cost-effective only for individuals living alone in another study. </span></li>
</ul>
<div><span style="color: #333333;">These findings should be interpreted with caution due to an overall lack of research, differences in included studies’ designs, and potential for bias.</span></div>
<div>Eight studies investigated training and education of staff caring for people with dementia. Specific findings were as follows:</div>
<ul>
<li><span style="color: #333333;">Four studies found that general staff training was cost-effective. One showed improvements in quality of life, agitation, and psychiatric symptoms. </span></li>
<li><span style="color: #333333;">One study reported that general practitioner training with patient counseling/support groups did not reduce time to institutionalization. </span></li>
<li><span style="color: #333333;">Mixed findings were noted for standardized dementia training programs (e.g., dementia care mapping). One study demonstrated cost-effectiveness. Another study found cost neutrality. A third study determined it was not one cost-effective.</span></li>
</ul>
<div><span style="color: #333333;">Limitations included potential for publication bias, heterogeneity of study methods, interventions, and outcomes, and limited evidence for each intervention category.</span></div>
<div>One study found that combined cognitive training and CST led to nursing home cost savings for PWD. However, this finding should be interpreted with caution due to high risk of bias and limited research.</div>
<div>In one study, cognitive therapy with a focus on self-management was associated with improved verbal fluency in PWD. This treatment resulted in no added cost. Further research is needed due to limited overall research.</div>
<div>Within one study, group-based joint reminiscence therapy showed no significant difference in outcomes or participation for PWD. Additional, high-quality research is indicated.</div>
